Healthcare Provider Details

I. General information

NPI: 1821117326
Provider Name (Legal Business Name): ASSISTED LIVING AT BLOOMFIELD MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 E AIRE LIBRE AVE
SCOTTSDALE AZ
85254-9221
US

IV. Provider business mailing address

6501 E GREENWAY PKWY SUITE 103-505
SCOTTSDALE AZ
85254-2065
US

V. Phone/Fax

Practice location:
  • Phone: 602-441-2563
  • Fax: 602-354-7129
Mailing address:
  • Phone: 602-441-2563
  • Fax: 602-354-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALH-4868
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberALH-4868
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberALH-4868
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALH-4868
License Number StateAZ

VIII. Authorized Official

Name: MISS BETH GLOVER
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 602-441-2563